title: Reference values of bone mineral density and prevalence of osteoporosis in Chinese adults.
abstract: We pooled bone mineral density (BMD) data published in 91 articles including 139,912 Chinese adults and then established a national-wide BMD reference database at the lumbar spine and femur neck for Chinese adults. The prevalence of osteoporosis in the middle-aged and elderly Chinese population was also estimated.
  
  
  BACKGROUND
  Well-accepted reference value of BMD is lacking in Chinese. We established the reference database and assessed osteoporosis prevalence based on published literature conducted in the Mainland China, Taiwan, and Hong Kong Chinese.
  
  
  METHODS
  We searched for all published articles indexed in MEDLINE, PubMed, CNKI, and SinoMed up to January 2013. We included cross-sectional studies that examined BMD using a dual-energy X-ray absorptiometry at the femur neck (FN) and/or lumbar spine (LS) in healthy adults. Overall age-specific mean (SD) BMD were pooled after standardization.
  
  
  RESULTS
  Ninety-one studies including 51,906 males and 88,006 females (≥ 20 years) in 38 cities in China were included in this pooling study. Gender- and age-specific reference curves of standardized BMD (sBMD) at the LS and FN were constructed. The sBMD cutoffs for osteoporosis classification were 0.746 and 0.549 in women, and 0.680 and 0.568 g/cm(2) in men; age-standardized prevalence of osteoporosis was 23.9 % and 12.5 % in women and 3.2 % and 5.3 % in men aged ≥ 50 years at the LS and FN, respectively. Meta-regression analysis showed that greater age and altitude, lower latitude, smaller city size, earlier detection time, and random sample were correlated to lower sBMD in at least one gender-specific bone sites; the Hologic DXA produced a higher value of FN sBMD than the other two devices (Lunar and Norland).
  
  
  CONCLUSIONS
  We have established a national-wide BMD reference database at the LS and FN for Chinese adults and estimated the prevalence of osteoporosis in the middle-aged and elderly Chinese population.
authors.affiliation: Guangdong Provincial Key Laboratory of Food, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, People's Republic of China.
authors.forename: Z-Q
authors.initials: ZQ
authors.lastname: Zhang
authors.forename: S C
authors.initials: SC
authors.lastname: Ho
authors.forename: Z-Q
authors.initials: ZQ
authors.lastname: Chen
authors.forename: C-X
authors.initials: CX
authors.lastname: Zhang
authors.forename: Y-M
authors.initials: YM
authors.lastname: Chen
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D015519:Bone Density / Q000502:physiology*; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D005272:Femur Neck / Q000503:physiopathology; D006801:Humans; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology* / Q000503:physiopathology; D015663:Osteoporosis, Postmenopausal / Q000453:epidemiology / Q000503:physiopathology; D015995:Prevalence; D012016:Reference Values; D017678:Sex Distribution; D055815:Young Adult